Individual
KRISTA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2500 N DETROIT ST, LAGRANGE, IN 46761-1158
(260) 463-2133
(260) 463-3775
Mailing address
PO BOX 236, LAGRANGE, IN 46761-0236
(260) 463-2133
(260) 463-3775
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004448A
IN
Other
Enumeration date
06/04/2024
Last updated
07/12/2024
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